X线、CT和MRI多模态影像对溶骨性转移瘤和骨质疏松致椎体压缩性骨折的诊断价值分析

The diagnostic value of X-ray,CT and MRI multimodal imaging in the vertebral compression fractures caused by osteolytic metastases and osteoporosis

目的分析X线、CT和MRI多模态影像对溶骨性转移瘤和骨质疏松致椎体压缩性骨折的诊断价值。方法回顾性分析浙江省中医药大学附属江南医院(萧山区中医院)2019年1月至2021年5月102例椎体压缩性骨折患者的基础临床资料及X线、CT、MRI影像学数据。其中,溶骨性转移瘤致椎体压缩性骨折47例,骨质疏松致椎体压缩性骨折55例。结果溶骨性转移瘤致椎体压缩性骨折患者年龄和骨质疏松率明显低于骨质疏松致椎体压缩性骨折患者[(61.95±11.84)岁比(72.37±12.55)岁和4.3%(2/47)比83.6%(46/55)],体质量指数和疼痛视觉模拟评分明显高于骨质疏松致椎体压缩性骨折患者[(22.58±3.85)kg/m2比(18.11±2.79)kg/m2和(8.31±2.91)分比(7.02±2.72)分],差异均有统计意义(P<0.05);两者性别构成比较差异无统计学意义(P>0.05)。溶骨性转移瘤致椎体压缩性骨折椎体形态楔形和双凹形率明显低于骨质疏松致椎体压缩性骨折[2.80%(3/107)比60.82%(104/171)和6.54%(7/107)比29.82%(51/171)],扁平形和后缘膨隆率明显高于骨质疏松致椎体压缩性骨折[75.70%(81/107)比9.36%(16/171)和14.95%(16/107)比0],差异有统计学意义(P<0.01);溶骨性转移瘤致椎体压缩性骨折椎弓根受累和软组织肿块率明显高于骨质疏松致椎体压缩性骨折[68.09%(32/47)比1.82%(1/55)和46.81%(22/47)比0],而椎体内线性影像信号率明显低于骨质疏松致椎体压缩性骨折[0比96.36%(53/47)],差异有统计学意义(P<0.01);两者椎体MRI信号比较差异有统计学意义(P<0.01),溶骨性转移瘤致椎体压缩性骨折以低T1高T2和低T1低T2为主,骨质疏松致椎体压缩性骨折以低T1高T2为主;溶骨性转移瘤致椎体压缩性骨折椎间盘压缩和增宽率明显低于骨质疏松致椎体压缩性骨折[4.26%(2/47)比34.55%(19/55)和2.13%(1/47)比18.18%(10/55)],差异有统计学意义(P<0.01或<0.05)。多模态影像诊断溶骨性转移瘤致椎体压缩性骨折和骨质疏松致椎体压缩性骨折的正确率均明显高于X线、CT和MRI(89.4%比51.1%、72.3%、83.0%和90.9%比52.7%、60.0%、78.2%),差异有统计学意义(P<0.05)。结论多模态影像有助于提高溶骨性转移瘤和骨质疏松致椎体压缩性骨折诊断的正确率,降低临床误诊率,对两者鉴别诊断有重要参考价值。

Objective To analyze the diagnostic value of X-ray,CT and MRI multimodal images in the vertebral compression fractures caused by osteolytic metastases and osteoporosis.Methods The basic clinical data and X-ray,CT,MRI imaging data of 102 patients with vertebral compression fractures from January 2019 to May 2021 in Jiangnan Hospital(Xiaoshan Traditional Chinese Medicine)Affiliated to Zhejiang University of Traditional Chinese Medicine were retrospectively analyzed.Among them,vertebral compression fractures caused by osteolytic metastases was in 47 cases,and vertebral compression fractures caused by osteoporosis was in 55 cases.Results The age and osteoporosis rate in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis:(61.95±11.84)years old vs.(72.37±12.55)years old and 4.3%(2/47)vs.83.6%(46/55),the body mass index and pain visual analogue score were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis:(22.58±3.85)kg/m2 vs.(18.11±2.79)kg/m2 and(8.31±2.91)scores vs.(7.02±2.72)scores,and there were statistical differences(P<0.05);there was no statistical difference in gender composition(P>0.05).The rates of vertebral body wedge shape and double concave shape in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis:2.80%(3/107)vs.60.82%(104/171)and 6.54%(7/107)vs.29.82%(51/171),the rates of flat shape and posterior margin swelling were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis:75.70%(81/107)vs.9.36%(16/171)and 14.95%(16/107)vs.0,and there were statistical differences(P<0.01);the rates of pedicle involvement and soft tissue mass in patients with vertebral compression fractures caused by osteolytic metastases were significantly higher than those in patients with vertebral compression fractures caused by osteoporosis:68.09%(32/47)vs.1.82%(1/55)and 46.81%(22/47)vs.0,while the rate of linear image signal in vertebral body was significantly lower than that in patients with vertebral compression fractures caused by osteoporosis:0 vs.96.36%(53/47),and there were statistical difference(P<0.01);there was statistical difference in MRI signals(P<0.01),vertebral compression fractures caused by osteolytic metastases were mainly characterized by low T1 high T2 and low T1 low T2,while vertebral compression fractures caused by osteoporosis was mainly characterized by low T1 high T2;the rates of disc compression and widening in patients with vertebral compression fractures caused by osteolytic metastases were significantly lower than those in patients with vertebral compression fractures caused by osteoporosis:4.26%(2/47)vs.34.55%(19/55)and 2.13%(1/47)vs.18.18%(10/55),and there were statistical differences(P<0.01 or<0.05).The accuracies of multimodal imaging in the diagnosis of vertebral compression fractures caused by osteolytic metastases and osteoporosis were significantly higher than those of X-ray,CT and MRI(89.4%vs.51.1%,72.3%,83.0%;90.9%vs.52.7%,60.0%,78.2%),and there were statistical differences(P<0.05).Conclusions Multimodal imaging is helpful to improve the diagnostic accuracy of vertebral compression fractures caused by osteolytic metastases and osteoporosis,to reduce the clinical misdiagnosis rate,with important reference value for the differential diagnosis of the two diseases.